Association of Autonomic Dysfunction With Disease Progression and Survival in Parkinson Disease

作者：Eduardo De Pablo‐Fernández, Carmen Tur, Tamás Révész, Andrew J. Lees, Janice L. Holton, Thomas T. Warner · 发表于：JAMA Neurology · 年份：2017 · DOI：10.1001/jamaneurol.2017.1125 · 被引用次数：246 · 研究领域：Parkinson's Disease Mechanisms and Treatments、Heart Rate Variability and Autonomic Control、Cardiovascular Syncope and Autonomic Disorders

Importance: Evidence suggests that development of autonomic dysfunction (AutD) may negatively affect disease course and survival in patients with synucleinopathies. However, the few available studies on Parkinson disease (PD) have conflicting results, comprise a small number of patients, have short follow-up periods, and lack pathologic confirmation of the diagnosis. Objective: To examine the association of time of onset of AutD with disease progression and survival in PD. Design, Setting, and Participants: This retrospective review of clinical data from 100 consecutive patients with an autopsy-confirmed diagnosis of PD from the archives of the Queen Square Brain Bank in London, United Kingdom, from January 1, 2006, to June 3, 2016, included patients with PD regularly seen by hospital specialists (neurologists or geriatricians) in the United Kingdom throughout their disease until death. Patients with dementia before or within 1 year after onset of motor symptoms, monogenic forms of PD, comorbidities that affect autonomic function, a coexisting neuropathologic diagnosis, or insufficient clinical information were excluded. Main Outcomes and Measures: Survival and time from diagnosis to specific disease milestones were calculated to assess disease progression. Autonomic dysfunction was defined as autonomic failure at autonomic function testing or 2 of the following symptoms: urinary symptoms, constipation, upper gastrointestinal tract dysfunction, orthostatic hypotension, sweati...